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Thursday, July 30 · 8 stories
- Federal Policy
CMS Finalizes 2.3% IPF Payment Increase for FY 2027, Delays Outlier Cap
CMS issued a final rule July 29 increasing inpatient psychiatric facility payments by 2.3% ($60 million) for fiscal year 2027, reflecting a 3.2% market basket update minus a 0.9-point productivity adjustment. The rule finalizes an outlier payment cap but defers implementation until FY 2028 and excludes facilities with fewer than 50 stays annually. CMS also removes two quality reporting measures on alcohol and tobacco screening effective CY 2026/FY 2028 and modifies implementation of the standardized IPF Patient Assessment Instrument with a lower compliance threshold and extended timeline. Changes take effect October 1, 2026.
Wednesday, July 29 · 6 stories
- Federal Policy
HHS Secretary Kennedy Convenes Health Plans and Providers on Behavioral Health Quality Pledge
HHS Secretary Robert F. Kennedy, Jr. held a roundtable with healthcare leaders, insurers, medical societies, and behavioral health providers who pledged to advance best practices for mental health and addiction treatment. The meeting occurred on July 29, 2026, at HHS headquarters in Washington. The voluntary commitments focus on improving care quality and patient outcomes across the behavioral health system. The initiative signals federal priority attention to behavioral health standards but lacks binding requirements or timelines for implementation.
- Federal Policy
KFF Analysis Finds SSI Applicants Face Coverage Risk Under Medicaid Work Requirements
KFF released a policy analysis examining how Medicaid work requirements could affect Supplementary Security Income (SSI) applicants. The analysis finds that SSI applicants are at heightened risk of losing Medicaid coverage due to challenges navigating the medical frailty exclusion verification process under work requirement policies. While individuals with disabilities are typically exempt from work requirements through medical frailty provisions, SSI applicants — who are in the process of establishing disability status — may struggle to document their conditions quickly enough to maintain continuous coverage. The analysis highlights operational barriers that could lead to coverage gaps for this vulnerable population.
- Federal Policy
CMS Re-Establishes Data Match With OPM for Marketplace and Medicaid Eligibility Verification
CMS has re-established a Privacy Act matching program with the Office of Personnel Management to verify minimum essential coverage through OPM health benefit plans. The data match enables CMS and State Administering Entities to determine eligibility for qualified health plans through exchanges and insurance affordability programs, including Medicaid and CHIP. The match supports initial eligibility determinations, renewals, redeterminations, and appeals. Effective July 29, 2026, this routine data exchange ensures states can verify coverage status when individuals apply for Medicaid or marketplace subsidies.
- Federal Policy
ACAP and CHCS Launch Technical Assistance Series on Medicaid Work Requirements
The Association for Community Affiliated Plans and the Center for Health Care Strategies announced a learning and action series to help safety net health plans implement newly established Medicaid work requirements. The initiative will provide technical assistance to plans as they develop operational processes for verifying beneficiary compliance, managing exemptions, and coordinating with state agencies. The timing suggests recent federal policy changes have authorized or expanded work requirement programs in multiple states. Safety net plans serving Medicaid populations will need new systems for tracking work activities, processing beneficiary documentation, and managing potential coverage terminations for noncompliance.
- Federal Policy
AHRQ Grant Spending Down 95% Despite Congressional Appropriation
The Agency for Healthcare Research and Quality has spent less than $15 million of its $345 million fiscal year 2026 appropriation on grants and has not issued new grants in over a year. The agency typically funds health services research including quality measurement, patient safety, and care delivery studies that inform Medicaid program design and quality initiatives. The spending freeze affects research that state Medicaid agencies and managed care plans rely on for evidence-based policy development, quality improvement, and payment reform.
- Federal Policy
Senator Kim Introduces MediKids Act for Universal Child Health Coverage
Sen. Andy Kim (D-NJ) introduced S. 5037, the MediKids Act, to establish guaranteed healthcare coverage for all children in America. The bill was cosponsored by four Democratic senators and referred to the Senate Finance Committee. No timeline for committee consideration has been announced. If enacted, the legislation would significantly expand federal health coverage for children beyond current Medicaid and CHIP eligibility thresholds, affecting state program design and federal-state financing arrangements.
Tuesday, July 28 · 7 stories
- Federal Policy
ACA Marketplace Enrollment Drops 15% After Enhanced Premium Tax Credits Expire in 2026
ACA Marketplace enrollment declined nationwide in 2026 for the first time in seven years following the expiration of temporary enhanced premium tax credits, with all states except New Mexico experiencing enrollment losses. Enrollment fell 15% on the federal marketplace (HealthCare.gov), while state-based marketplaces saw smaller declines averaging 6%, particularly in states that partially offset the federal subsidy loss with state funds. The enhanced subsidies, which had driven enrollment growth since their introduction, expired at the end of 2025.
- Federal Policy
CMS Proposes Removing 638 Additional Procedures from Medicare Inpatient-Only List for 2027
CMS proposed removing 638 procedures from the Medicare Inpatient Only List in the CY 2027 OPPS/ASC Proposed Rule, effective January 1, 2027. This follows removal of 285 procedures in CY 2026. The broader scope includes surgical services beyond the 2026 focus on musculoskeletal procedures. The removals affect whether procedures must be performed in inpatient settings or can shift to outpatient settings under Medicare payment rules.
- Federal Policy
HHS OIG Audits Department AI Governance Framework for Federal Compliance
The HHS Office of Inspector General has initiated an audit examining whether the Department of Health and Human Services has established adequate governance for developing and deploying artificial intelligence tools across its operations. The audit will assess compliance with federal requirements, including National Institute of Standards and Technology AI risk management standards and departmental policies. The review covers AI governance structures affecting HHS agencies including CMS. The audit's scope and timeline for completion have not been publicly specified.
- Federal Policy
CMS Proposes Mandatory 340B Claims Data Reporting for Medicare Part D
CMS published the 2027 Physician Fee Schedule proposed rule on July 16, proposing to make 340B claims data reporting mandatory for covered entities participating in Medicare Part D, converting what was previously a voluntary submission. The proposal would require 340B covered entities to submit Part D claims data to the Medicare Part D Claims Data 340B Repository starting in 2027. This change affects hospitals, federally qualified health centers, and other 340B covered entities that dispense drugs under Medicare Part D, requiring new compliance infrastructure and potentially increasing administrative burden for entities that have not voluntarily reported to date.
- Federal Policy
CMS Electronic Prior Authorization Requirements Take Effect January 1, 2027 for Medicare Advantage and Medicaid Managed Care
On January 1, 2027, Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, and federally facilitated exchange QHP issuers must support electronic prior authorization through standardized APIs under CMS's 2024 Interoperability and Prior Authorization final rule. The rule requires impacted payers to enable providers to determine prior authorization requirements, submit requests, and receive approval decisions electronically through EHR integration, using standardized HL7 FHIR-based workflows. The rule does not eliminate prior authorization or change medical necessity criteria — it standardizes the electronic exchange of prior authorization information between providers and health plans. Hospitals should engage EHR vendors and health plans now to prepare workflows, test systems, and train staff before implementation.
- Federal Policy
CMS Publishes Q2 2026 Quarterly Listing of Medicare and Medicaid Program Issuances
CMS published its quarterly compilation of manual instructions, regulations, and Federal Register notices issued between April and June 2026 for Medicare, Medicaid, and other CMS-administered programs. This is a routine administrative notice that compiles previously issued guidance and rulemakings from the quarter into a single reference document. The listing provides a consolidated index of policy issuances for stakeholders tracking program changes. This quarterly publication serves as an administrative record and reference tool rather than announcing new policy.
- Federal Policy
CMS Proposes Home Health Enrollment Changes to Reduce Fraud and Improper Payments
On July 1, 2026, CMS proposed enrollment-related policy changes under the Home Health Prospective Payment System aimed at reducing improper Medicare payments and protecting beneficiaries. The proposed rule introduces new enrollment requirements and fraud deterrence measures for home health providers. While the rule targets Medicare home health providers, states with Medicaid home health programs or 1915(c) waiver programs providing home and community-based services may see similar enrollment standards adopted or referenced in future Medicaid guidance. CMS has not specified a comment deadline or effective date in the summary provided.
Monday, July 27 · 5 stories
- Federal Policy
HRSA Rural Maternal Health Program Reaches 8,600 Women Across Three States
The Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies Program (RMOMS) improved prenatal and postpartum care access for more than 8,600 women through networks in Minnesota, Missouri, and West Virginia, according to a 2026 program report covering the second cohort. The program addresses maternal care gaps in rural areas where provider shortages and hospital closures limit access to obstetric services. RMOMS networks coordinate care across providers, implement telehealth, and expand midwifery services to maintain maternal health infrastructure in underserved communities. For Medicaid agencies and managed care organizations covering rural populations, the program demonstrates models for sustaining maternal care capacity where traditional hospital-based delivery is no longer viable.
- Federal Policy
CMS Proposes Rule Implementing H.R. 1 Provider Tax Restrictions
CMS issued a proposed rule on July 21, 2026, implementing two of three provider tax restrictions from H.R. 1, which limits states' ability to use provider taxes to finance their Medicaid share. The rule prohibits new provider taxes and increases in existing taxes. This affects state Medicaid financing strategies and budget planning, with implications for how states fund their programs and potential pressure on state general funds. The proposal will proceed through standard notice-and-comment rulemaking.
- Federal Policy
FDA Raises Safety Concerns About Compounded GLP-1 Drugs as Alternative to Ozempic
The FDA and physicians are expressing concern about compounded versions of GLP-1 drugs like Ozempic, which patients are increasingly using as cheaper, more accessible alternatives. These compounded formulations, while easier to obtain, carry serious safety risks according to medical experts. The issue affects Medicaid beneficiaries who may turn to compounded versions due to cost or access barriers with brand-name GLP-1s. This raises questions for state Medicaid programs about coverage policies, prior authorization criteria, and quality oversight for diabetes and weight management drugs.
- Federal Policy
HHS Appeals Court Ruling Invalidating 2025 ACA Marketplace Rule Provisions
The Department of Health and Human Services filed an appeal to reinstate portions of a 2025 Affordable Care Act rule that a federal judge invalidated in June 2026. The invalidated provisions include shortened enrollment periods and stricter eligibility verification requirements for marketplace coverage. The appeal seeks to restore these requirements, which originally applied to ACA marketplace plans beginning with the 2026 plan year. The outcome affects marketplace operations and enrollment procedures, with potential implications for Medicaid-marketplace coordination on eligibility determinations and transitions between coverage types.
- Federal Policy
CMS Proposes Mandatory Attestation Process for Off-Campus Hospital Outpatient Departments
The Centers for Medicare & Medicaid Services has proposed a new process requiring hospitals to submit provider-based attestations for off-campus hospital outpatient departments, converting what was previously a voluntary submission into a mandatory requirement. The proposed rule establishes a compliance framework for hospitals operating off-campus HOPDs under provider-based status. CMS has not specified an effective date or comment deadline in the available information. This change affects hospitals billing Medicare and Medicaid for services delivered at off-campus locations under provider-based arrangements, requiring new administrative processes to maintain compliance and avoid potential payment denials.
Friday, July 24 · 7 stories
- Federal Policy
No Surprises Act Disputes Rose 16% in Second Half of 2025
Providers and payers initiated 16% more disputes under the No Surprises Act in the second half of 2025 compared to the first half, according to new CMS data released July 23, 2026. Arbiters are closing cases more quickly and working through the backlog of disputes. The No Surprises Act primarily governs commercial insurance out-of-network billing disputes and does not apply to Medicaid managed care or fee-for-service.
